Assessment-related anxiety among older adults: associations with neuropsychological test performance.

Anxiety disrupts test performance across academic/testing contexts; however, the impact of anxiety on neuropsychological testing has been examined less frequently among older adults, despite clinical observations of high anxiety and dementia worry among elderly individuals in assessment contexts. The present study examined the impact of trait, state, and test anxiety on measures of processing speed, working memory, verbal memory, and aspects of executive functioning (i.e., set shifting and inhibition). We hypothesized that anxiety specific to neuropsychological assessment would correlate with test performance more consistently than state or trait anxiety. Ninety-three older adults aged 55 to 89 underwent a three-and-a-half-hour comprehensive assessment battery measuring anxiety and neuropsychological test performance. All participants completed the Feelings About Neuropsychological Testing State (FANT-S) and Test (FANT-T) questionnaires, Generalized Anxiety Disorder-seven item (GAD-7), and neuropsychological tests in the domains of processing speed, working memory, verbal memory, and executive functioning. When test scores were regressed on these anxiety measures, increases in test anxiety predicted decreased performance on measures of executive functioning, specifically inhibitory control. State anxiety demonstrated the opposite relationship to performance and predicted increased performance on one measure. Trait anxiety did not predict cognitive assessment performance. Findings were consistent with previous research indicating measures of test anxiety are more sensitive to changes in test performance than measures of trait or state anxiety. Results demonstrated that older adults, even those not referred for a clinical neuropsychological assessment, can show decreased test performance when self-reported anxiety relevant to the neuropsychological assessment context is high.

Influence of Acceptance and Commitment Therapy Core Processes on Anxiety and Stress in Persons With Spinal Cord Injury: A Cross-sectional Study.

OBJECTIVE: To explore the relationship between the core Acceptance and Commitment Therapy (ACT) processes (mindfulness, self as context, acceptance, defusion, values, and committed action) and anxiety and stress in a sample of individuals with spinal cord injury (SCI). DESIGN: Variance accounted for by ACT on anxiety and stress as outcome variables was examined using multiple linear regression. SETTING: Study measures were completed via online survey. PARTICIPANTS: 159 participants with a SCI completed self-report study measures relevant to the ACT core processes as well as measures of depression, anxiety, and perceived stress. MAIN OUTCOME MEASURES: Outcome measures included the Spinal Cord Injury-Quality of Life Anxiety subdomain and the Perceived Stress Scale. RESULTS: Higher reported engagement with acceptance (ß=0.238, P=.004), pursuit of values (ß=0.187, P<.008), and defusion (ß=0.351, P<.001) related to less anxious distress. Perceived stress was predicted by depression (ß = 0.230, P=.038) and the ACT core processes as a whole (P<.001). CONCLUSIONS: The results of our study indicate that considerable variance in anxiety and stress in individuals with SCI is accounted for by the core processes of ACT. Lower levels of anxiety and stress were predicted by the ACT components as a whole. Anxiety was uniquely predicted by pursuit of values, acceptance, and defusion, indicating these 3 components of ACT may be particularly beneficial in the treatment of anxiety in SCI. These results may provide targeted treatment opportunities via tailored ACT-based interventions.

Assessment-related anxiety among older adults: development of a measure.

Older adults are the largest population seeking neuropsychological assessment services. Anxiety has been shown to impact test scores, yet no anxiety measure currently exists specific to older adult neuropsychological assessment. This study piloted and validated the Feelings About Neuropsychological Testing measure (FANT), a measure of neuropsychological assessment anxiety developed to measure the cognitive, affective, and physiological aspects of test and state anxiety. The measure was validated on 105 community based older adults aged 55 and older. All participants were administered the FANT, the Generalized Anxiety Disorder- seven item (GAD-7), Test Anxiety Inventory- Short Form (TAI-SF), Patient Health Questionnaire- nine item (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), Dementia Worry Scale (DWS), and PROMIS Cognitive Function Short Form- 6a (CFSF). The measure proved feasible to administer, both the State and Test-specific dimensions demonstrated good internal consistency (state: α =.832; test: α =.894), discriminant validity, and external validity (compared to GAD-7, TAI-SF, PHQ-9, DWS, and CFSF). FANT scores may reveal patients for whom anxiety disrupts attention and attentional control, and therefore has promise as a measure that may inform assessment findings and guide possible intervention to maximize performance during testing sessions and to inform data interpretation.